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Last Updated: Monday, 7 July, 2003, 16:05 GMT 17:05 UK
Diary of a Liberian aid worker II
Medecins Sans Frontieres is one of the few aid agencies still working in Liberia.

Tom Quinn, who works for MSF, is writing a diary for BBC News Online.

Tom Quinn
Tom Quinn who works for MSF in Liberia

1400 GMT, 4 July

We're setting up a therapeutic feeding centre with for over 500 children from the camps in Monrovia's northern outskirts.

MSF has been trying to give medical care to around 18,000 people living in Seghbe, Plumcor and Rick's camp and the number of severely malnourished children we've been seeing lately is alarming.

This won't solve the problem of hunger, but at least it will stop them starving to death.

The material for the centre along with more general medical supplies are on their way from Brussels - we have over 80 tonnes of aid arriving so there's lots of preparation to be done.

As it's relatively quiet, I'm also taking the opportunity to catch up on some paperwork and to be honest I'm really appreciating the break.

Sometimes it's hard to keep on going at full speed - you need a breather.

Besides, it's easy to get caught up in the overall urgency and it's important that you keep checking over the figures, collecting and going over medical evidence, to make sure our programmes are targeted and effective.

Sounds boring but it can make the difference between saving lives and wasting money.

Anyway, I'm a bit tired at the moment and want to get on with this work so I'll be off. More later.

1600 GMT, 2 July

You could almost think Monrovia was returning to some sort of normality: there was no gunfire last night and for the first time in weeks I heard no reports of looting or street violence.

But then you look at hordes of people crammed in the city centre and the faces of starving children in the camps, and you realise that just because the shooting has stopped it doesn't mean the crisis is over.

Far from it. As supplies diminish and hygiene deteriorates it only gets worse. This is a complete and utter catastrophe.

We now have over 130 patients in our cholera treatment unit and are in the process of building another to deal with the overflow.

People are lying three to a bed and if you've ever seen cholera you'll know just how bad that is.

Out in the camps, the people talk constantly of food.

They are so very hungry.

It's now too dangerous for them to travel to the fields to work or collect firewood so all they can do is forage in the nearby forest for anything vaguely edible and there's not much.

The lack of protein in the diet has meant many of the children are suffering from oedema - a severe form of malnutrition.

We are rushing these children to a feeding centre as they need 24-hour intense care, but it doesn't solve the problem for the rest of the camp population.

They need a proper distribution of food and they need it immediately.

But more about that later. A boy has just been brought in. He's been hit by a motorbike and is bleeding badly; it looks like an artery.

I've got to go help him.

1500 GMT, 30 June

I'm tired. Absolutely exhausted. Imagine how it must be for these families.

Tens of thousands of them have gathered in central Monrovia, trying to find shelter anywhere they can.

Think of the crowds after a football match, only a hundred times bigger, with no toilets, no food, no running water and nowhere to go.

There is uncontrollable looting with shootings and rape. It's a nightmare.

And from a medical point of view an absolute disaster: People are starving, cholera is spreading and Monrovia's health system has collapsed.

Rotting bodies

It's been a little quieter over the past few days so we have been using the opportunity to reach our clinics and the camps.

There are so many spent bullet cartridges on the road that you have the sensation of driving over marbles, and in the northern suburbs the streets are absolutely empty save for wired-looking kids with guns.

And rotting bodies. It's eerie.

Back in the camps we're greeted with the same dancing and singing as always but the people are losing hope.

They live in constant fear and at the mercy of armed gangs that sweep through their shelters, stealing what little they have and raping their women.

Hard choices

The only end they can see to this living hell is if the international community decides to send troops to halt the bloodshed.

Otherwise, they're just waiting for the next bout of fighting. It's so hard to know where to begin to help them.

As a medical organisation MSF is faced with certain difficult choices.

The medical needs of Monrovia's population are overwhelming but we can't do everything at once.

To make matters worse, the constant looting and ever present threat of resumed fighting mean that we have to be prepared for anything and be very, very careful.

So right now the most urgent needs are treating war-wounded, cholera and malnutrition and of the three (and now that there are fewer war-wounded coming in) we've decided to really concentrate of doing what we can to get cholera under control.

Inspiration

So I'm off back to the compound and to decide with the team exactly how we're going to go about this.

I think one of the first moves will be to build a cholera unit closer to home so that if the fighting resumes we are still able to treat people in this part of town.

Thank God for our national staff, as there's no way we could do any of this without them.

We have nearly 300 national staff and their families now living with us in the compound and the staff have been working 72 hours straight.

We would be nowhere if it weren't for their mind boggling dedication. They really are an inspiration.

1115 GMT, 27 June

Grace is about 11 or 12 years old and she is going to lose her leg.

Her mother is here with her and has also been hit by shrapnel.

Her seven-year-old sister is across town and if she doesn't lose her life then she will certainly lose her arm. She has a bullet lodged in her head.

Fortunately the father and baby brother are more or less unhurt.

Mindless war

The relative calm in Monrovia means that we are going to be able to drive this family across town to join the other daughter and receive further treatment.

But there are many more like them who won' t be so lucky. And these are just civilians; women and children who want no part in this fighting.

If they had somewhere else to run to they would. But it is they who pay the price of this mindless war.

As you drive around Monrovia the few people you see, turn to the sound of the car with terror and run to get out of your way.

Bullets

Trigger happy kids have taken to terrorising Monrovia's streets, doped up to the eyeballs and armed to the teeth, looting whatever they find.

Yesterday they tried to take our car. Last night they attacked the embassy next door.

The embassy has armed guards who managed to fend them off but the shooting was so close it seemed as though bullets would fly through the walls at any moment.

You couldn't help wondering if the looters would attack us next.

MSF has no armed guards. Fortunately we have always commanded enough respect to not need them - understanding who we are and what we do is the strongest protection we have.

Let's hope it holds.

Miracle twins

And now I have to go visit some of the clinics. One had mortars landing right next door and received many war-wounded.

Others are running very low on drugs, which I'll be able to help with this afternoon. We're still receiving cholera patients but not as many as before.

I'd like to hope it was because the numbers were dropping but I suspect it's more likely to be because people are too afraid to leave their homes and seek treatment.

But just when you think it's all too much something happens.

This morning, in this compound, we performed our first Caesarean section.

Where just a few hours before we had nothing, not even a clinic, we can now perform minor surgery.

And the result is two beautiful, healthy, baby girls. Twins, named after the MSF doctor and surgeon who delivered them. Nathalie and Juanita.

1100 GMT, 26 June

It is horrific.

People are bleeding all around us.

We have been swamped with patients and many of them are in a critical condition.

Most of these patients are the result of the attack yesterday afternoon on the compound next to the US embassy, just 400m from where we are here.

As we brought the bodies into our compound bullets whizzed over our heads.

Surgery

We are trying to do all we can for the wounded, who number well over 100 in our compound.

And we are now set perform minor surgery.

But many of the injuries are serious.

One man has had his arm blown off while two have died already.

Earlier on we were able to transfer some of the most critical in a convoy to the International Committee of the Red Cross surgical unit across town.

But it is too dangerous to do that now.

Perhaps if the present quiet continues we might have a chance.

Shelling

It is near impossible to know what is going on outside these walls.

Last night's shelling was further away than it was the night before and today has been relatively quiet.

I cannot say whether it is because the rebels are retreating or they are just pausing while they eat their breakfast.

Who knows what is going on in this chaos?

Meanwhile we are struggling to deal with just what we have here.

As well as the patients we have all the medical staff and their families living in the compound.

Children

Everywhere there are people.

You look under the stairs and there is a family.

You look under the tables and there are some children.

We are all on a diet of high energy biscuits as we have no idea when we will be able to get more food supplies in.

Let us just hope this quiet lasts.

Strangely enough I am not scared - what happens, happens.

But I am very worried for these people.

1000 GMT, 25 June

It's happening again only this time it's far worse.

The fighting is approaching central Monrovia again and we are now trapped in the compound, doing our best to deal with the steady stream of war-wounded coming through our doors.

Yesterday morning we drove as usual to the camps.

We heard bombing and shelling several kilometres to the north but that's not too unusual and we weren't too alarmed.

Then we noticed that the government troops had retreated behind us, and with the rebels to the north that meant we were trapped in the middle.

We decided to leave immediately taking the back roads.

Hospital evacuated

From there it continued. There was small arms fire around us.

We evacuated the patients from Redemption Hospital and brought some of them back to the compound.

And everywhere we went we saw people on the move; tens of thousands of people fleeing the fighting.

Back in the compound we, and a small number of national staff who are staying with us, have been desperately trying to reinforce our facilities.

Cholera epidemic

Last night we heard rockets and shelling in Monrovia's centre just one or two kilometres away and we have a steady stream of war-wounded coming in to our small in-patient facility that we set up during the last bout of fighting.

We need to be able to do light surgery to treat these patients.

Redemption Hospital has been evacuated and the ICRC surgery unit is on the other side of town - far too dangerous for anyone to cross town right now - so we're going to have to be able to operate on them here.

And in the middle of this nightmare we have a cholera epidemic.

Yesterday we had 111 admissions to our cholera unit and now we can't reach it because of fighting.

What is going to happen to all those people?

And the thousands more still living in stadiums and schools, soon to be descended upon by the tens of thousand more.




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